Experts from the Rutgers Center for Tobacco Studies discuss the public health challenges of menthol in cigarettes

No Menthol Sunday on May 21 is an annual observance led by the Center for Black Health & Equity to encourage communities to address the detrimental impact of tobacco on Black communities and ask faith leaders to educate their congregants about smoking and the role of menthol and flavored products.

This year’s theme, “Focus on Victory, Go Against the Grain,” encourages people to stand up against the tobacco industry and create healthy and just tobacco-free communities.

Several faculty at the Center for Tobacco Studies (CTS) have contributed to the substantial evidence base that supports a ban on menthol in cigarettes. Cristine Delnevo, director of the Center for Tobacco Studies (CTS) and a professor at the Rutgers School of Public Health, and Andrea Villanti, deputy director of CTS and an associate professor at the Rutgers School of Public Health, have published multiple studies and were expert reviewers of the Food and Drug Administration’s (FDA) “Scientific Assessment of the Impact of Menthol in Cigarettes.” Kymberle Sterling, the incoming associate director for diversity, equity and inclusion at CTS and an associate professor at the School of Public Health also previously published studies that examined the role of flavored tobacco products and marketing on addiction.

The three explain why No Menthol Sunday matters.

Why should menthol cigarettes concern public health officials?

Delnevo: The FDA’s Tobacco Product Scientific Advisory Committee was tasked by Congress to review the scientific evidence of menthol cigarette use among specific groups given the high use rates among youth and Black people who smoke. It concluded that menthol in cigarettes reduced the harshness of smoking and was associated with increased initiation, higher dependence and had lower quit success.

The continued availability of menthol cigarettes in the U.S. should be viewed as a social justice issue. The majority of Black people who smoke cigarettes in the U.S. smoke menthol cigarettes and there is extensive research showing that the tobacco industry has targeted Black and African American communities with advertising for menthol cigarettes for decades.

Our study, published in the journal Nicotine & Tobacco Research, draws attention to other populations for which menthol use is high, including sexual minorities, pregnant women and those with mental health problems.

Sterling:  In a previous study, we also found that Black adults who smoked menthol cigarettes were more likely to dual use other flavored tobacco products, like flavored cigarillos. The use of menthol and other flavored tobacco products may contribute to increased smoking-related illnesses and death among Blacks compared to whites. 

How can we achieve health equity in the face of local, state and national policies that restrict or ban menthol cigarettes? 

Villanti:  In our commentary published in JAMA Network Open, we suggest a range of activities that include: culturally appropriate communication efforts to raise awareness and counter misperceptions and disinformation about the goals of flavored tobacco policies; policy enforcement focused on retailers and manufacturers; limited policy exemptions to prevent loopholes or inequitable implementation; and culturally appropriate, free and accessible resources to support tobacco cessation.

Sterling: Most importantly, we must acknowledge the historical context and the current role of systemic racism and oppression that has bolstered the tobacco industry’s promotion of its deadly products to Blacks.

Armed with this acknowledgment, we can develop effective local, state and national policies to restrict or ban menthol cigarettes and make strides to dismantle systems of racism and oppression that have undermined tobacco health equity efforts.

What are the ways in which we can support people who want to quit smoking menthol cigarettes?

Villanti:  State-level quitlines provide essential access to tobacco cessation resources. In addition, there may be several ways to increase Quitline engagement and reach, especially among vulnerable communities.

To that end, we recently published an article in Health Promotion & Practice describing the initial benefits of quitline financial incentives to increase counseling sessions among adults who use menthol tobacco products. In the first program of its kind, the Vermont Tobacco Control Program added a financial incentive protocol specifically for callers using menthol tobacco products to their quitline, 802Quits, in December 2021 in collaboration with National Jewish Health, Vermont’s quitline contractor.

Callers using menthol tobacco products earned $150 over five coaching calls to align with the other 802Quits financial incentives. From March 2021 to May 2022, 66 quitline callers enrolled in the menthol incentive protocol, representing 8 percent of all quitline callers and 25 percent of participants in the state’s quitline incentive programs. A greater proportion of callers in the menthol incentive program completed three or more quitline calls (58 percent versus 38 percent) and enrolled in phone and text support (61 percent versus 32 percent). 

This novel approach may be applied in other states with menthol or flavored tobacco restrictions as part of health equity efforts within states or as part of a national strategy to support menthol tobacco users motivated to quit in response to policy change.

Consistent with the theme of 2023 No Menthol Sunday, we must focus on helping smokers be victorious in quitting with the help of innovative and effective cessation programs. 

Sterling:  We encourage people with an interest in quitting to reach out to the Tobacco Dependence Program at CTS, which has helped thousands of smokers to quit.  There also other national, state and local resources that can help menthol smokers to quit. It is hard to quit, but there is help.